Provider Demographics
NPI:1013912831
Name:KAVORKIAN, VERONICA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:ANNE
Last Name:KAVORKIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2701 CHAMBERLAIN LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-1603
Mailing Address - Country:US
Mailing Address - Phone:502-243-9044
Mailing Address - Fax:502-243-8482
Practice Address - Street 1:2701 CHAMBERLAIN LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-1603
Practice Address - Country:US
Practice Address - Phone:502-243-9044
Practice Address - Fax:502-243-8482
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY34912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY080191473OtherRAILROAD MEDICARE
KY64032741Medicaid
KY64032741Medicaid
0680401Medicare PIN